# EAGLE ROCK DENTAL CARE ARCO PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457608671
- **Authorized official:** TRUDEE L CHAPPLE (OFFICE ADMINISTRATOR)
- **Authorized official phone:** (208) 523-5400

## Contact information

- **Practice address:** 520 HIGHLAND DR., ARCO, ID 83213
- **Practice address phone:** (208) 527-3472
- **Mailing address:** 520 HIGHLAND DR., PO BOX 5, ARCO, ID 83213
- **Mailing address phone:** (208) 527-3472

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D-3271 | ID | — |
| 122300000X | Dentist | D4224 | ID | — |
| 1223G0001X | General Practice Dentistry | D1608 | ID | — |
| 1223G0001X | General Practice Dentistry | D1890 | ID | Yes |
| 1223G0001X | General Practice Dentistry | D3063 | ID | — |
| 1223G0001X | General Practice Dentistry | D4138 | ID | — |

## Other

- **Enumeration date:** 08/07/2012
- **Last updated:** 03/14/2014